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. 2025 Feb 25;10(1):e70104.
doi: 10.1002/lio2.70104. eCollection 2025 Feb.

Complementary Reinnervation in Unilateral Vocal Fold Paralysis

Andreas H Mueller  1 , Kathleen Klinge  1 , Gerhard Foerster  1 , Fabian Burk  1
Affiliations

Complementary Reinnervation in Unilateral Vocal Fold Paralysis

Andreas H Mueller et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: To achieve glottal gap closure in unilateral vocal fold paralysis (UVFP) through complementary ansa cervicalis nerve muscle pedicle laryngeal reinnervation (ANMP-LR).

Introduction: ANMP-LR is easy to learn and does not require recurrent laryngeal nerve (RLN) transection.

Materials and methods: Twelve patients with unilateral vocal fold paralysis (UVFP) were included, who received ANMP-LR and could be followed up for at least 6-24 months. At baseline, after 3-6 (T1), 12 (T2) and 24 months (T3), Voice Handicap Index (VHI), perceived roughness (R) and breathiness (B), sound pressure level (SPLmax), maximum phonation time (MPT), Dysphonia Severity Index (DSI) and glottal gap (GG) were recorded.

Results: R and B were significantly reduced at T1, MPT and SPLmax increased significantly up to T1 (MPT to 15.8 s; SPLmax to 91.5 dB). Similarly, VHI dropped significantly and the residual glottal gap (GG) was significantly reduced between T0 and T1. All outcomes remained stable until T3. There was a non-significant tendency to further improvement until T3 in SPLmax and GG.

Discussion: The T1-T3 outcomes of the complementary ANMP-LR are comparable with the standard LR and also with thyroplasty. As with all LR techniques, younger patients and those with shorter paralysis benefit more. Patients with evidence of unfavorable laryngeal synkinesis are more likely to benefit from a standard LR with RLN transection.

Conclusions: Younger patients with insufficient synkinetic reinnervation and persisting or progressive glottis closure insufficiency in UVFP benefit from early reinnervation. When the easy-to-learn ANMP technique is used, any partial rehabilitation that has already been achieved or any remaining chance of spontaneous reinnervation via the RLN is not compromised.Level of Evidence: 3.

Keywords: ansa cervicalis nerve‐muscle pedicle; atrophy prevention; complementary reinnervation; early intervention; unilateral vocal fold paralysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Surgical principle of the complementary ACNM‐LR. The ansa cervicalis nerve (ACN) is rerouted by transection of the inferior root and a distal branch with a small muscle pedicle is transferred to the TA/LCA complex via a thyroid lamina window. The damaged recurrent laryngeal nerve (RLN) with potential resting innervation remains untouched. Source: Open source larynx drawing from Wikimedia Commons [19] adapted by the author A.M.
FIGURE 2
FIGURE 2
Box plots of the assessed voice parameters at the time points T0–T3. Panel a: Roughness (R, dimensionless). Panel b: Breathiness (B, dimensionless). Panel c: Maximum phonation time (MPT in seconds). Panel d: Maximum sound pressure level (SPLmax, in decibel). Panel e: Dysphonia severity index (DSI, dimensionless). Panel f: 12‐item‐Voice Handicap iIndex (VHI‐12, dimensionless). ***p < 0.001, **p < 0.01, *p < 0.05, n.s.‐(not significant).
FIGURE 3
FIGURE 3
Change in the laryngoscopically assessed glottal gap. (a) Preoperative (T0) laryngoscopic images of the respiratory position (top) and maximum closure during loud phonation (bottom) of a patient with left‐sided UVFP after replacement of the subclavian artery 6.5 months previously. Notice the residual glottal gap (GG) reaching the anterior commissure corresponding to a GG‐Value of 5. (b) Boxplots of the rating results concerning the GG for T0–T3. (c) Laryngoscopic images of the respiratory position (top) and maximum closure during loud phonation (bottom) of the same patient as in panel (a), 24 months after surgery (T3). Complete closure is achieved corresponding to a GG value of 0. Note the medially rotated left vocal process (top image) as an indication of reinnervation of the lateral cricoarytenoid muscle.
See this image and copyright information in PMC

References

    1. Kissel I., Meerschman I., Tomassen P., D'Haeseleer E., and van Lierde K., “Experiences of Patients With Unilateral Vocal Fold Paralysis: A Mixed‐Methods Study of the Insider's Perspective,” Journal of Voice (2024): S0892‐1997(24)00096‐1. - PubMed
    1. Mueller A. H., “Active and Passive Bioimplants for Vocal Fold Paralysis,” Laryngo‐ Rhino‐ Otologie 101 (2022): S144–S159. - PubMed
    1. Dhillon Vaninder K. and Akst L. M., “Vocal Fold Immobility: An Algorithm for Treating Glottal Insufficiency,” in Advances in Neurolaryngology, ed. Prasad V. M. N., Remacle M., Prasad V. M. N., and Remacle M. (S.Karger AG, 2020). - PubMed
    1. Rapoport S. K. and Courey M. S., “Type I Thyroplasty and Arytenoid Adduction: Review of the Literature and Current Clinical Practice,” International Journal of Head and Neck Surgery 12 (2022): 166–171.
    1. Peetermans O., Lavrysen E., Deben K., Varebeke S. J. D., Vanderveken O., and Desuter G., “Modern Management of Unilateral Vocal Fold Paralysis: How We Do It,” B‐ENT 19 (2023): 267–273.

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